Drivers of Energy Consumption in Portuguese Hospitals - a panel analysis

Abstract Background Buildings represent about 40% of global energy consumed, playing an important role in sustainable transformation. Health institutions account for 10% of the energy consumed by the commercial sector, however public policies do not cover energy management in this setting. Energy poverty in hospitals, such as poor heating, affect patients’ and workers’ health and wellbeing. As such, this study aims to analyse drivers of electricity and natural gas consumption of Portuguese hospitals. Methods Data regarding 25 hospitals in Portugal’s National Health Service from 2015-2020 were analysed as logarithms in a panel of 18 trimesters, using Panel-corrected Standard Errors estimators. The PSAR model considers the presence of an autocorrelation within the panel, and the Hetonly modeling deals with heteroscedasticity and autocorrelation. Results There is an elastic elasticity and a statistical significance of electricity and natural gas consumption in relation to the number of beds occupied, with a greater variation of natural gas than electricity consumption. In turn, there is a predominance of an inelastic elasticity of electricity and natural gas consumption in relation to the number of workers and number of emergency episodes. Conclusions Energy consumption is highly influenced by the number of beds occupied, highlighting the need for a strategic management of energy and planning of hospital capacity. Overall, the positive absolute effects of the elasticities for energy consumption reveal that hospitals do not use effective measures aimed at rational and cleaner energy consumption, requiring a paradigm shift in the energy matrix. Increasing energy efficiency policies and environmental practices, such as autonomous energy production and renewable energies, might effectively contribute in reducing conventional energy consumption and associated energy poverty, which in turn improve patients’ and workers’ conditions within the hospital and their health and wellbeing. Key messages • Strategic energy management and capacity planning can contribute to lower energy poverty and a paradigm shift in the energy matrix. • Hospital sustainability policies must include energy management, including autonomous energy production and investment in renewable energies.


Background:
It has long been a maxim of climate and health research that heatwaves kill more people than all other natural disasters combined. Heatwave frequency, severity and duration have increased as climate change intensifies, and recorded temperatures during recent heat events now regularly surpass previous worst-case projections. Temperate zones, between 40 -60 north or south of the Equator, are particularly vulnerable, as small variations in mean temperature can trigger large-scale increases in morbidity, mortality and concomitant health service strain. Heat Health Warning Systems (HHWSs) combine temperature forecasts with public health actions to mitigate these impacts. However, in the absence of a consensus definition of heatwaves multiple systems have developed, and comparative analysis of the effectiveness of different HHWS and their interventions are hindered by lack of a common threshold metric for defining and predicting heatwave severity.

Methods:
This paper provides a comprehensive review of current HHWS and their evidence base in temperate zones in Europe, the United Kingdom and Australia -contiguous landmasses containing multiple jurisdictions with high heterogeneity in local HHWSs, in which single heatwave events trigger vastly different public health responses. A systematic review of available published and grey literature was undertaken to generate a schema of HHWSs in these zones. Results were then narrowed to review and synthesise evidence for each, with a focus on threshold effectiveness in predicting health impacts.

Results and conclusions:
Over twenty distinct HHWS are reviewed, with substantial variation in the evidence for their effectiveness. We make the case for a unified threshold metric for defining heatwaves, to facilitate research and identify warning systems which accurately predict health impacts and effectively communicate risk. Key messages: Lack of definitional consensus and heterogeneity in threshold metrics hinders comparison of Heat Health Warning Systems.
Accurate prediction and rapid communication of heat risk is crucial to prevent health impacts of heatwaves. The air monitoring data and parameters such as exposure-response factors will support the risk assessment in AirQ+ software (WHO Regional Office for Europe). Preliminary results showed that exceedances of Air Quality Directive in Portugal ranged between 0.1 % and 10.2% for PM10 and PM2.5 in 2019. Results obtained will include the number of cases of CVD attributable to exposure to PM2.5 in the Portuguese population. Four scenarios of exposure will be considered for presenting the results: current scenario of exposure, new WHO Air Quality guidelines, European Commission Air Quality Directive and lastly, a worst-case scenario. This assessment will be the starting point for calculation of the burden of disease of CVD that exposure to PM2.5 represent in Portugal. With a view to promote the science to policy interface, PMCardImpact project will make available to policy makers the needed supporting information to act, including actionable knowledge on air pollution trends and related health effects, to implement reducing air pollution policies. This work is funded by FCT/MCTES through national funds to PMCardImpact (EXPL/SAU-PUB/0944/2021) and CESAM (UIDP/50017/2020 + UIDB/50017/2020 + LA/P/0094/2020). Key messages: PMCardImpact will make available to policy makers the needed supporting information to act to implement reducing air pollution policies. Risk assessment will allow to determine the number of CVD cases attributable to air pollution.
Health institutions account for 10% of the energy consumed by the commercial sector, however public policies do not cover energy management in this setting. Energy poverty in hospitals, such as poor heating, affect patients' and workers' health and wellbeing. As such, this study aims to analyse drivers of electricity and natural gas consumption of Portuguese hospitals.

Methods:
Data regarding 25 hospitals in Portugal's National Health Service from 2015-2020 were analysed as logarithms in a panel of 18 trimesters, using Panel-corrected Standard Errors estimators. The PSAR model considers the presence of an autocorrelation within the panel, and the Hetonly modeling deals with heteroscedasticity and autocorrelation.

Results:
There is an elastic elasticity and a statistical significance of electricity and natural gas consumption in relation to the number of beds occupied, with a greater variation of natural gas than electricity consumption. In turn, there is a predominance of an inelastic elasticity of electricity and natural gas consumption in relation to the number of workers and number of emergency episodes.

Conclusions:
Energy consumption is highly influenced by the number of beds occupied, highlighting the need for a strategic management of energy and planning of hospital capacity. Overall, the positive absolute effects of the elasticities for energy consumption reveal that hospitals do not use effective measures aimed at rational and cleaner energy consumption, requiring a paradigm shift in the energy matrix. Increasing energy efficiency policies and environmental practices, such as autonomous energy production and renewable energies, might effectively contribute in reducing conventional energy consumption and associated energy poverty, which in turn improve patients' and workers' conditions within the hospital and their health and wellbeing. Key messages: Strategic energy management and capacity planning can contribute to lower energy poverty and a paradigm shift in the energy matrix. Hospital sustainability policies must include energy management, including autonomous energy production and investment in renewable energies.